Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 16/2012management system, workers in the lowest positions are indicated by the letter A (i.e.commesso), followed by the B level (i.e. coadiutore amministrativo), whereas the middlelevels are indicated respectively by the letters C and D (i.e. assitente amministrativo andcollaboratore amministrativo). 5 Finally, the person in charge of each hospital’s operatingstructure is an administrative employee of D level who is given specific responsibilities.Obviously, the wage for each level depends on the corresponding hierarchical position.A potential explanation of hospital’s inefficiency can be ascribed to this hierarchical pyramidrather than to the total number of employees. Figure 1 is the graphic interpretation of thisthesis, taking hierarchical pyramids of efficient and inefficient hospitals into consideration. 6Figure 1: Italian administrative hierarchical pyramid: Efficient vs. inefficient hospitalsLevel APeople in charge0.50.40.30.20.10Level DEfficient hospitalsInefficient hospitalsLevel BLevel CIndeed, if there is no significant relation between hospitals’ inefficiency and the number ofadministrative employees, their distribution in this pyramid might be the real cause of badperformance. In other words, there could be a relation between hospitals’ inefficiency and anexcessive number of employees in the highest levels (i.e. too many individuals in chargeand/or too many D-level workers). We can observe this situation in Figure 1. In efficienthospitals (i.e. the sub-sample of observations with score equal to 0) there are relatively moreemployees in the lower levels (B and C) than in the higher ones (i.e. people in charge and D);whereas inefficient hospitals (i.e. the sub-sample of observations with a score higher or equalto 1) display a bigger relative number of employees in the higher levels (i.e. people in charge5 Italy’s public administrative structure within the Health Care System can be better understood by looking at the currentnational work contract, i.e. “Contratto Colletivo Nazionale di Lavoro del personale del comparto del servizio sanitarionazionale quadriennio normativo 2006-2009 e biennio economico 2006-2007”. Notice that the same hierarchical structure isapplied by all Italian hospitals since the cited national work contract is the common legal frame-work for the whole country.What can change is the allocation of employees in each level, according to the specific center’s organization.6 Efficient hospitals are observations with a score equal to zero, whereas inefficient ones are observations with a score equalor higher than one. The values showed in the figure are the mean of these two sub-samples of observations.11